Access Health

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Access Health
The Muskegon County, Michigan Business
Model National Association of Counties Milwaukee,
Wisconsin
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Muskegon, Michigan

• Located along Lake Michigan, 40 miles NW
  of Grand Rapids
• A diverse population of about 170,000
• Primarily a service sector economy
• Uninsurance rate of about 11

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Profiling Coverage in Muskegon
Distinctive Populations With Distinctive Needs
Commercial Plans 102,000
Privately funded coverage
Working uninsured 17,000
Access Health targets
Medicare/caid 45,000
Government sources of coverage
SMP 2,000
Muskegon Care Safety Net Coverage
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Cost of Commercial Products as a Barrier
EPIC-MRA 1999 Survey of 200 Uninsured Businesses
in Muskegon County
- 75 have fewer than 4 fulltime employees -
45 pay between 6 - 12 /hr to fulltime - 69
identify cost of premiums as reason - 81
would offer affordable coverage - 95 able to
afford 35-50 premium rates - 67 indicated
coverage would reduce turnover - 72 said fear
of future premium increases prevented offering
coverage
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Survey of Working Uninsured
48 not offered coverage 16 offered - but
refused 64 coverage extremely important 30
forgo treatment of illness 65 able to pay 35 to
50 pm/pm 154 average cost of premiums where
offered
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Community Governance

• Access Health, Inc. established, 501c3
• Community based Board of Directors
• Directly contracts with LOCAL providers
• Case management to improve health status
• Local management of payment and claims/iNET

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Access Health Market

• 500 local businesses
• Full and part-time employees
• Children ages 19 23
• Identify government coverage
• Medicaid (Healthy Kids)
• SCHIP (MIChild)

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Eligible Businesses
Located in Muskegon county No health
insurance for 12 months Median wage of 11.50
per hour
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(No Transcript)
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Access Health Benefits Offering Every Health
Service in Muskegon County

• Physician Services
• In-patient hospital services
• Out-patient services
• Emergency Room services
• Ambulance services
• Behavioral health

Prescription drugs (formulary) Diagnostic lab
and x-rays Home health Hospice Care Accept
pre-existing conditions
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Exclusion - Care
Any care received outside of Muskegon County
Certain highly specialized catastrophic care -
limb reattachment - neo natal - transplants -
severe burns
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Sharing the Cost
Uses a three-share model to reduce cost
Employer pays 30 Employee pays 30 Community
pays 40
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Affordable Coverage

• Physicians and other medical providers also share
  the financing - 4th Share
• Medicare 20 rates (discounted)
• 10 is retained by Access Health

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AH Cost of Coverage
   EMPLOYER   EMPLOYEE   COMMUNITY   TOTAL ADULT
    46 / mo.    46 / mo.    56.00/
mo.    148.00/ mo.     552 / yr.    552 / yr.
   672.00/ yr.    1,776.00/ yr. CHILD     29
/ mo.    29 / mo.    37.50 / mo.    95.50 /
mo.     348 / yr.    348 / yr.    450.00 /
yr.    1,146.00 / yr.
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Coverage Co-payments
5 PCP office visits 20 Specialist office
visit 20 Urgent care center visit 5 Generic
formulary drugs 50 Non-generic formulary
drugs (total drug cost paid by Access Health not
to exceed 6,000 per calendar year per
member) 50 Emergency Room visit 50 Outpatient
hospitalization 100 Inpatient hospitalization 5
Home Care visit 0 Hospice visit 20 Outpatient
behavior health services
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Access Health A County - State Partnership

• Municipal Health Facilities Corporations
  Act - Act 230
• Allows Michigan Counties to develop County Health
  Plans
• Disproportionate Share Hospital Dollars
  Fund - local match
• County takes responsibility for services to
  Indigent - SMP
• Bipartisan Support in Michigan

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Muskegon i-Net Software

• Internet-based case management
• Local claims payment service
• Community-based treatment
• Tracks utilization and costs
• Health improvement evaluation

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New Health Care Funding Resources

• 2 million annually in DSH
• Two direct federal appropriations - 900,000
• State Tobacco Settlement funds - 250,000
• National legislation S906 - tax credits for
  small business
• Federal TOP grant for software/case management
• Federal CAP grant for member education
• HRSA partnership to work with other communities
• EBRI white paper for public policy makers

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Access Health Accomplishments

• Over 1,200 individual served last year
• Over 400 businesses
• 97 of all local physicians participate
• Only 46 a month per member
• 1 public dollar leverages 2 private dollars.
• Hundreds of children identified for
  SCHIP/Medicaid

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Interest in Access Health

• Small Group Market inflation
• - Chambers of Commerce Osceola County,
  Florida
• - U.S. House Small Business Committee
• - Blue Cross/Blue Shield groups
• - Medical Community
• - Think Tanks
• Federal Community Access Program
• - State Planning Groups Utah, Delaware
• - Local Communities Richmond, VA/
  Rockville, MD
• - HRSA Technical Assistance partnership

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Other 3-Share Programs

• Huntington, West Virginia
• Rockford, Illinois
• San Diego, California
• Franklin, Logan and Scott Counties, Arkansas
• Cumberland, Maryland
• Olympia, Washington
• Jackson, Mississippi

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Policy Wins

• Uses Local Match - no state funds
• Puts new money in the pipeline
• Saves Safety Net resources
• Helps curb cost-shifting to business
• Helps small business market
• Economic Development tool box item
• Better health status
• Reduces personal bankruptcy - slow pay/no pay

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University of Illinois Survey Lessons From 75
Access Health Businesses

• 57 of respondents had never previously offered
  health insurance
• 49 are now likely to purchase commercial
  coverage and would prefer to deal with agent who
  sold them Access Health
• 49 indicate Access Health helped morale and
  productivity
• 33 indicate Access Health improved
  profitability
• 36 indicate that AH helped them recruit and
  retain workers

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For more information about Access Health and our
other projects, please visit our website.
http//www.mchp.org
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Vondie Woodbury, Exec. Director
Muskegon Community Health Project 565 W. Western
Avenue Muskegon, Michigan 49441 Phone 231
728-3201 Email vwoodbury_at_mchp.org